Article
Summative Analysis: A Qualitative Method for
Social Science and Health Research
Frances Rapport, PhD
Head of the Qualitative Research Unit
Professor of Qualitative Health Research
Swansea University
Swansea, Wales, United Kingdom
© 2010 Rapport. This is an Open Access article distributed under the terms of the Creative Commons
Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use,
distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
In this paper the author describes a new qualitative analytic technique that she has
been perfecting across a range of health research studies. She describes the
summative analysis method, which is a group, collaborative analytic technique that
concentrates on consensus-building activities, illustrating its use within a study of
Holocaust survivor testimony that aimed to clarify how health and well-being were
presented in Holocaust testimonials and what that might reveal about professional
perceptions of trauma suffering. The author contextualizes the four stages of
summative analysis with data from one Holocaust survivor’s health interviews. The
Holocaust study is briefly described, as is the survivor’s background and experiences
during the war. The author reflects on the study data and offers examples of
individual and group analysis exercises to represent the method in practice. The
author concludes with a consideration of the wider uses and implications of
summative analysis within health and social scientific contexts.
Keywords: summative analysis, collaborative working, Holocaust data, health
interviews, building consensus, qualitative methodology
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Purpose
The purpose of this paper is to describe a new qualitative research method, summative analysis,
which the researcher has been developing over the past four years to effectively manage,
organize, and clarify large bodies of qualitative, textual data. Summative analysis is a
collaborative analytic technique that enables a wide range of researchers, academics, and
scientists to come together through group analysis sessions to explore the details of textual data. It
uses consensus-building activities to reveal major issues inherent in data. The method has
purposefully been called summative analysis rather than collaborative analysis or any other term,
in spite of its collaborative aspect, to emphasize the value placed on the form of working:
Summative analysis prepares people to grasp an essentialized understanding of text.
To emphasize the versatility of the method, the author has worked with others to apply
summative analysis across a variety of research studies, settings, and textual data types, such as
•
focus groups with people at risk of breast cancer to consider the value of electronic
decision aids for supporting their decisions for care (Rapport, Iredale, et al., 2006);
•
biographies from general practitioners and community pharmacists to clarify situated
practice and patient-centered approaches to work across community workspaces
(Rapport, Doel & Elwyn, 2007; Rapport, Doel, & Wainwright, 2008); and
•
Interviews: with gastroenterologists and nurse managers to examine innovation in
endoscopy services across 40 National Health Service (NHS) trusts in England (Rapport,
Jerzembek, et al., 2009).
The author begins the paper by describing the choice of summative analysis as a method and its
various uses before presenting the most recent use of the method: a Holocaust study that aimed to
explore ‘how notions of health and well-being were in evidence in survivor testimonies and what
narrative forms they took’. The Holocaust study aimed to clarify what survivor testimonies might
tell us about the ongoing health needs and expectations of people who have suffered
extraordinary, traumatic events like the Holocaust. The overall objective of the study was to
consider how health professionals might best support survivors and their families, through wellattuned understanding of their mental and physical health needs and through a greater
understanding of the value of the health narrative in assisting with the clinical encounter.
This paper does not present the Holocaust study as an empirical study per se but, rather, in
relation to the analytic method, using examples taken from the study to illustrate different stages
of the method and to situate that knowledge in very practical and real terms. Having described the
Holocaust study, the author describes the four stages of summative analysis using examples from
the study. The paper concludes with a discussion of the wider implications of summative analysis
for qualitative researchers and social scientists so that others might consider its place in their own
research portfolio.
Choosing summative analysis
Qualitative researchers and social scientists now have an array of choices regarding the analysis
of qualitative data and the representation of their data as results. Consequently, it is important that
principled, informed, and strategic decisions are made, in line with the specific purposes of the
research in question. Qualitative researchers must also reflect on the methodological issues
related to the construction of each kind of data representation. For example, constructing a
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standard realist tale from data can often be effective, as Van Maanen (1998) has noted, if one
wishes to take account of experiential authority, the research subject’s point of view (in the form
of closely edited quotations), and the interpretive omnipotence of the researcher. Sparkes (2002)
has commented that when well crafted, realist tales can provide useful, compelling, detailed, and
complex depictions of social worlds. Summative analysis cannot offer interpreter omnipotence,
nor can it enable the researcher to put to the background the ethnographer’s intent, whilst giving
the author unchallenged authority in writing (Sparkes, 2002; Van Maanen, 1998). What it can
offer, moving away from this notion of being overly deterministic with a text, are opportunities
for analytic creativity.
As described earlier, the method is versatile and has been used across a range of studies.
However, it should be noted that summative analysis is particularly useful for texts that are
complex or cover sensitive topic areas. It is supportive of those studies where method choices are
not readily made and where outcomes are not easily achieved. It works best with diverse data,
whether snippets of text, or long, meandering tracts. It enables data that do not fit a mold to be
considered, offering more flexibility of working, with sensitive support from others. It has the
potential to generate a range of insights and reflections and can provide a careful approach to
emotive materials that some researchers might be uncomfortable working with. It enables
researcher to be aware of more nuanced and ambiguous aspects of text, where tales are not given
up easily. It preserves the quality of the speaker’s voice irrespective of the mode of presentation,
and it is fully involving of experts from, for example, across both physical and mental health care
backgrounds, to consider issues beyond the researcher’s own knowledge, such as those relating to
trauma presentation. It is inclusive of a wide variety of others’ views, revealed through both
group-working and consensus-building activities, and as a consequence, one of its greatest
strengths is its potential to enable an egalitarian approach: everyone’s view matters; all members
are included. This has a strong leveling effect on working practice.
Summative analysis, when appropriately facilitated, offers the opportunity to embrace the
research subject while involving teams of coresearchers (the term used in this paper though they
can also be described elsewhere as research participants), who can join in with the researcher in
the analysis process and who can help in the consideration of data representation. The term
coresearcher has been chosen to emphasize the ability of others to work closely with the
researcher in analyzing data. Whereas the researcher has overall accountability for the study, the
coresearchers take on a commitment to be fully involved in all analysis sessions. By so doing,
coresearchers must be aware of the importance of the collaborative aspect of the method and of
developing a negotiated understanding of a text.
The group of coresearchers involved in summative analysis work can be selected for a variety of
reasons: their homogeneity as a group who are either familiar with the topic area in question or
with the people in question, their impartiality to the subject area or people in question, their
expertise or insider knowledge, or their lack of expertise. The choice of coresearchers, as with
other group working methods, is dependent on the individual study, the needs of the researcher,
the research question, or study aims. In the case of this work, with stories taken from Holocaust
survivors, six to nine people took part in 12 two-hour workshops, (some groups returned on a
further two occasions to complete all three group-working sessions). Administrative processes
related to summative analysis are not onerous and involve contacting coresearchers to organize
the workshop sessions, providing them with the raw data and the group’s work in progress, and
ongoing liaison across sessions. Coresearchers were chosen in this study to purposively cover as
wide a range of research backgrounds and academic levels as possible, to encourage a wide
spread of research experiences (they were all involved in academic or health research but had a
breadth of knowledge, working across disciplinary groups, and spanning early-stage researchers
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to senior academics). Finally, the researcher wanted an approach that could accommodate the
complexity of this kind of data and the “drama” that might be contained within it so that the
strong emotional impact of the issues revealed would be reflected, rather than diminished or
flattened by the outputs.
Summative analysis: the method
All analysis, including qualitative analysis has a reductive element to it (Miles & Huberman,
1994), and summative analysis is no exception. However, within the reductive process, as
summative analysis undertakes a search for the essential elements of a text, it continues to
consider the importance of the text as a whole and its impact on speaker and audience.
Essential text, for summative analysis purposes, refers to those elements of the text that offer a
point of entry into the meaning of the whole text, and that give the text its import. These must be
considered in their own right and can be discussed and clarified through group-working
techniques. The essential elements are those without which, it could be argued, there could be no
fully coherent understanding of the text. Essential text does not purport to an idea of an essential
“truth” inhabiting the text but, rather, a range of truths, which can be negotiated by the group in
question as those clear aspects of narrative that hold the key to understanding. Essential text, for
summative analysis purposes, can include data regarding context, personal experience, emotional
content, or the complex nature of human thought. In the case of a Holocaust survivor’s transcript,
group members could seek to understand, first individually and then as a group, how the
storyteller offers key ideas, descriptions of behaviors, conversations, and connections that appear
to be integral pathways through research conversations with the researcher. These suggest a
particular point of view, and when considering what they might be, the researcher and
coresearchers take into account the way events are recounted within or without chronological
order, and the way stories can provide vital insights into an experience like the Holocaust, as
lived.
Coming to recognize the critical moments, also known as eureka moments or precious vignettes,
that can be discovered in a story allow coresearchers to appreciate those elements that give a text
its unique resonance. The essential qualities of a text can be found in all textual forms, be they
interview transcripts, biographic accounts, or focus group transcripts, with marginalized or
mainstream groups. It is up to the coresearchers, supported by the study researcher, to discover
this for themselves during Stages 2 to 4 of the method (see below), having first undergone
individual analytic work during Stage 1 (see below).
Undertaking summative analysis with a similar section of text but with more than one group of
coresearchers, where similar outcomes are apparent, can help validate the group-working
approach. In the case of the Holocaust study (see below) an excerpt of text from one survivor’s
health interview was considered across all the workshops, with each coresearcher group
providing a similar response to the text. This was recognized through the groups’ summative
maps (see Stage 2 of the method below) and led to a clear understanding of the validity of this
approach. Summative analysts also consider the relationship between the whole and parts of any
text, and between the speaker, listener, and audience. With these issues apparent, the researcher
can develop greater clarity regarding the key notions portrayed. This is an in-depth exercise, and
in a sense these aspects of the method, particularly the search for a relationship between parts of
the text and the whole text, is not dissimilar to the work of hermeneutic phenomenology.
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Hermeneutic phenomenologists consider the interplay between part and whole; reading parts of
the text and testing out what might be contained within the whole of the text, before returning to
the specific and the particular (Jasper, 2004; Thompson, 1981). They also strive to achieve an
“essential” understanding of the phenomenon under review. However, in hermeneutic
phenomenology the intention is to understand how objects, events, or situations are “given up” to
consciousness to clarify their primal impression and the essential quality of knowing (Husserl,
1931), whereas in summative analysis it is not the experience of knowing that is so intriguing, nor
how objects or experiences present themselves to consciousness. Rather, it is the meanings people
give to those experiences that are sought and the way meaning is derived through the narrative
presentation. In this respect, summative analysts try to find out more about people’s lived
experiences by examining the meanings that they themselves give to their lives, meanings that are
inherent in their ordinary language. This depends on consideration of the storytellers’ words and
their ability to open up the story as well as the overall uniqueness of the story. Max van Manen
(1990), through his “sententious approach” (the term van Manen uses), encourages us to
understand both sections of text and the whole text by examining: “what it is that renders this or
that particular experience its special significance . . . what constitutes the nature of this lived
experience” (p. 32). However, in hermeneutic phenomenology this process is seen in terms of a
continuous spiral where hermeneutic knowledge is never complete, but open for new
understandings (The Hermeneutic Circle, Gadamer, 1977), whereas in summative analysis it is a
journey toward knowing.
For the purpose of this paper, it is worth clarifying that the author considers the interviews that
took place with one Holocaust survivor,1 Anka (the protagonist of this piece of work), as text. It
has been argued that talk and text are two very different things and that one is not commensurate
with the other, that they are produced according to different norms, for different purposes, and
that some aspects of the performative experience are lost in the translation (Hammersley &
Atkinson, 2001; Silverman, 2001). The author would agree that transcribing speech inevitably
leads to further layers of interpretation and loss of some performative elements of telling, one
stage further removed from the original. However, for analytic purposes there will always be
some interpretation involved at whatever level, whether we are working directly from a tape
recording of the original event, from notes, with speech itself or with a transcribed interview.
Summative analysis handles both concise and extensive texts. It also enables researchers to work
with widely differing population groups; minority groups, disenfranchised groups, and dispersed
populations as well as tightly knit communities. The method is flexible enough to be considered
inclusive of a range of narratives, and encourages groups of coresearchers to tackle texts that as
individuals they might consider too complex, or emotionally charged. Consequently, summative
analysis lends itself to an accommodation of difference, difficulty, and dissimilation as opposed
to similarity, ease of handing, and togetherness, and is particularly useful for researchers dealing
with others’ trauma, sense of dislocation, or deep distress. It retains the richness and variety of
different people’s views and voices while looking to group opinion to direct the analysis. It
involves group activities that are highly participatory and works with knowledge that is
cumulative, whereby coresearchers come to “know” the data intimately, by participating in indepth discussion and debate. Understanding develops across meetings, and a commitment of two
to three group meetings is usually necessary. Coresearchers support the main study researcher,
who may also be the facilitator of the analysis sessions, lending their voice to analysis and
becoming closely involved with the data under study. The main study researcher is ultimately
accountable for the work and is expected to have a thorough understanding of all aspects of the
study and its workings. Coresearchers may join an analysis group of six to nine people voluntarily
in an unpaid role, for example, if they are members of a higher education institution where
knowledge acquisition about methods development is expected and seen as part of their personal
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development, or they may be paid, if, for example, they are joining the analysis group from an
external organization or taking part as a result of topic area expertise. The makeup of the group
and financial reimbursement are dependent on the demands of each individual study, and it is up
to the main study researcher to organize.
Coresearchers for this study, were chosen purposively from across a wide group of researchers,
academics health professionals, and other professionals in one higher education institution
according to people’s interests in learning about the method, their desire to learn more about the
impact of traumatic events on health and well-being, their ability to take time to get involved with
this particular body of work, their decision to dedicate three sessions to clarify the relationship
between the analytic method and raw material. Coresearchers do not need to be from the same
disciplinary background, nor must they have a similar, intimate understanding of the topic area.
They do not necessarily have to be selected for their homogeneity as a research group, though
they may be chosen for that very reason. Rather, the criteria for the group of analysts, as with
many other qualitative, group-working methods, are sufficient interest in: the subject area, the
research methodology and the group-working process, that lends itself to consensus-building.
Summative analysis group-working meetings take between 1 and 2 hours, with the time period
dependent on the coresearchers’ ability to voice their views, consider others’ views, discuss the
richness of data, and recognize unique qualities inherent in the voice of the storyteller, an integral
part of each group session. See Table 1 for key aspects of summative analysis.
Summative analysis was used most recently with a study of Holocaust survivors, which will now
be presented, followed by an explanation of the four steps of the method. The Holocaust study is
described first, as the method uses examples from this study to explain the approach in more
detail. The study was granted ethical approval, in accordance with the ethical principles of the
researcher’s higher education institution in the United Kingdom.
The Holocaust study
Holocaust survivors who consented to take part in the study agreed to tell the researcher their life
stories, including life history and health history, work closely with the researcher throughout the
course of the study, consider outputs from data analysis, and discuss these with the researcher
during study output development. Plans for analysis of large quantities of textual data included
Table 1. Key aspects of summative analysis
Summative Analysis
Consensus of opinion through group-working activities
Participation from people with varying degrees of understanding and experience of qualitative methods
Multidisciplinary group working to ensure wide-ranging and rich life experiences are brought to bear
Analytic consideration of large or small sections of text including texts covering complex subject matter
Wide range of potential research subjects providing narrative data, and an especially useful method for working with
sensitive or difficult data from the disenfranchised, peripheral, dispersed, or disempowered
Involves consideration of content and context as well as the voice of speaker and her presentational style
Stepped approach to analysis, across two to three workshop sessions, building understanding iteratively and over time
Development of individual and group paragraphs describing and defining key aspects of the text’s content for group
discussion
Individual and group work to clarify the fundamental meaning of a text and its properties
Discloses a more nuanced and complex understanding than could be achieved using individualistic, self-contained
analytic techniques
Begins with succinct presentation and work toward an elaboration of understanding (as opposed to other qualitative
methods)
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applying a range of techniques to different elements of the testimonies. Life histories, for
example, were analyzed using ethnographic poetic methods, leading to ethnographic poetic
representations and performative social science presentations (see, for example, Rapport &
Sparkes, 2009). Health interviews were analyzed using summative analysis, which is described in
detail in this paper. Since this work was conducted, 11 summative analysis workshops have been
given across the United States and United Kingdom using excerpts from one of Anka’s health
interview transcripts (see details in this article) to present the four phases of the method to mixed
disciplinary groups of health researchers, social scientists, and methodologists and to ensure that
the method was fully operational before using it across a range of other research studies. In this
paper the researcher explicates the four methodological stages and the results of workshop
outputs with the Holocaust data to enable others to use the method.
The origins of the Holocaust study were multiple research conversations that took place between
a qualitative health researcher (FR) and three Holocaust survivors, the only three remaining
survivors now resident in southeast Wales, United Kingdom. All three were female, in their 80s
and early 90s, and, having spent time in Auschwitz-Birkenau concentration camp, all had left
their Eastern European countries of origin to start a new life in the West.
All research coresearchers agreed to take part in this study and signed a consent form to that
effect before any data were collected. Coresearchers were made aware of the process of data
collection, were aware that others besides the researcher would be included in the group analysis
work, and that coresearchers would be privy to elements of the stories. Coresearchers were also
told that their involvement would be sought to view study outputs and comment on specific
aspects of the work, to ensure their full agreement with the continued dialogue with the
researcher. As Frank (2005) has remarked, the dialogical in research is much more than just
listening and recording others’ life stories, it is neither static nor external to the process of telling,
but deeply involving as an act of engagement:
The researcher, by specific questions, and even by his or her observing presence,
instigates self-reflections that will lead the respondent not merely to report his or her
life, but to change that life. (p. 968)
However, it is important to note that Anka and the other people who contributed their Holocaust
narratives were not involved in the summative analysis work or in condoning or discouraging
those activities, nor were they expected to take on the role of researcher or coresearcher.
Although dialogical relationships are integral to the development of respect and understanding
between researcher and subject (Frank, 2005), those who contribute stories are not likely to have
the research experience or interest necessary to critique the complex research processes.
However, the dialogical relationship that develops between storyteller and researcher allows the
researcher to share insights into how the work is developing or to present the storyteller with the
outcome of the work. In the case of the summative analysis work with Anka, she was informed
during various stage of the process of how the study was developing, and she reviewed the group
paragraph from Stage 3, in the same way that she read the ethnographic poetic representations
produced from other analyses (Rapport, 2008). She was grateful at being included in these further
stages of the work and delighted to describe to the researcher her recognition of the close
relationship between the group-work and her actual story. Although researchers should not feel
obliged to change the process or outcomes of their work, they bear a certain responsibility to their
storytellers to share aspects of the work if the storyteller so wishes and, by so doing, respecting
the shared relationship of taking and giving back in return.
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The study complied with the regulations of the higher education institution’s ethics committee
where the researcher is based, which approved the study. Pseudonyms were not appointed,
whereas first names were in agreement with research participants’ wishes. This was the result of
participants’ dismay at the idea of their names not being linked to their stories. Indeed, they were
adamant that as these were their stories, pseudonyms would detract from their impact and that
including first names should be seen as a major element of the telling.
Anka, the protagonist of this paper, was one of the survivors. She presented the researcher with a
rich oral testimony during lengthy conversations in the familiar surroundings of her own home.
The research conversations lasted approximately 10 hours in total, generating 250 pages of
transcript in which Anka disclosed a world of degradation and loss. They also provided insights
into the impact of the Holocaust on her sense of self and her perception of health, illness and
well-being. The summative analysis work that follows concentrates, however, on a section of text
taken from one of her health interviews
Anka’s story
This section presents an abbreviated version of Anka’s life history (as she recounted her life
story, from beginning to end). It derives from a number of life history interviews that took place
between Anka and the researcher over the course of research conversations. As the life history
took many hours to tell, each interview had as its focus a particular part of her life (childhood and
adolescence, Holocaust camp years, postwar life, present day), and this section refers to Anka’s
life as she told it, whereas her first-person account has been changed to a third-person account, in
view of the fact that the researcher compiled this presentation from Anka’s words. This
abbreviated life history is included here to enable the reader to understand something of the
context within which her biographical journey took place. The summative analysis work that
follows, however, concentrates on one aspect of her life history: her health and well-being,
including mental well-being, with particular emphasis on her years in the camps.
The health interviews, from which information about her health and well-being were derived,
formed an important element of her story, and she described her views on her own health and the
health of those around her, including close family and friends, before, during, and after the camp
experience. Anka’s health and well-being were a particularly significant aspect of her story for
this researcher, whose study interest centered on a greater understanding of the relationship
between health and extraordinary life events. Consequently, the summative analysis work in this
paper involves an excerpt from one of the health interviews, to continue this theme. However
summative analysis can be used for all aspects of a story and is flexible enough to be applied to a
range of narrative presentations.
Born in Czechoslovakia at the time of the Austro-Hungarian Empire, Anka was brought up in a
Jewish community within a wealthy, middle-class family. Although Jewish, her family believed
that one’s religious leanings were unimportant, and her father was considered “a freethinker.” She
was schooled in Czechoslovakia and was halfway through a law degree when Hitler closed the
Czech universities and her life changed irrevocably. Following her marriage on May 15, 1940, to
a German-Jewish refugee, Anka underwent voluntary relocation to follow her husband’s transport
to Terezin concentration camp. At the beginning, it was presented by the Nazi regime as a sort of
work camp for the able bodied and the young, but in time the full horrors of the camp became
clear. When parents, siblings, and other family members joined her, they were less able to cope
with the rigors of daily life. Three and a half years later, having lost her first child at 2 months to
pneumonia, Anka was moved again, this time east to Auschwitz-
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Birkenau. Terezin was being evacuated, and only the bare minimum was to be left behind. Anka
was later to realize that if her baby had not died, she would not have survived Terezin. As it was,
her husband and family were never seen again.
In the early stages of a second pregnancy, Anka arrived in Auschwitz-Birkenau under the rule of
Mengele. She lived in huge barracks with hundreds of other Jews, naked, heads shaven, and
starving. There was a dreadful sense to the place: the chimneys, the smell, and nobody knowing
what was happening or what was to be expected. Ten days from the day of arrival, having
undergone innumerable roll calls, clothed in rags and with wooden clogs for shoes, she was
moved again, this time west, to barracks in Freiberg, 10 miles from Dresden. There she was to
make the V1 bomb, the Doodle Bug. In early April 1945, when her pregnancy was clearly visible,
Anka was taken on a 3-week open-carriage train journey to Mauthausen concentration camp.
Upon arrival she was placed upon a cart to ascend the hill to the camp. On the way back down,
surrounded by people who had either died or were dying of typhoid fever and with millions of
lice crawling around her, her second child was born. She named her Eva. It was three days before
the end of the war, April 29, 1945.
Eva weighed three pounds, Anka weighed five stone; with no baby clothes to hand, the child was
wrapped in paper found in the cart where Eva was born. Three days later, when the Americans
arrived, declaring an end to the war and armed with chocolate bars, she and the baby went to
Prague to live with her cousin. During the 3-year period she spent with Eva in Prague, Anka met
her second husband, and following their marriage the family emigrated to the United Kingdom,
where they have lived ever since.
Presentational effect
As the excerpts below and in Table 1 indicate, Anka’s oral testimony unfolded as life history
(recounting her life story, from beginning to end), personal memoir (creating her own
autobiography, recounting specific moments, events, people, circumstances that made up her
lived experience of the Holocaust) (Muncey 2010), and social history (contextualizing her life
story and autobiographical account through social and historical contexts), through a tapestry of
complex political, contextual, and social threads. From early childhood to young adulthood in
Czechoslovakia, from time spent under Nazi rule to freedom in the West, from a close and loving
secular Jewish family to total separation and disjuncture in the camps, Anka’s story is
remarkable. Sixty years later she still recalls the Holocaust in sharp focus, using a slow and
thoughtful presentation style. In the same measured way, Anka describes her family and friends,
the lengthy roll calls in the camps, and the attempts to stave off the cold, hunger, and despair that
stemmed from lack of food, degrading and inhumane conditions, and the bitter Eastern European
winter.
Through the telling, a relationship developed between Anka and the researcher, bound together
by the enduring story. Anka’s voice predominated with few interruptions from the researcher.
Anka’s speech lacked emotion, which was all the more shocking for the occasional fractured
pause. However, Anka kept in close contact with the researcher following the conversations and
was keen to welcome her into her home to talk about life, family, and the details of her story long
after the initial research conversations were complete. The examples below emphasize Anka’s
tempered style:
At first you think that you have got mad . . . We got into the barracks and one of my
friends whose parents were in the same transport said: “when will I see my
parents?” . . . That affected them and they started screaming, “you idiots they are in
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the chimney by now.” Well if somebody tells you that you think they are mad. And
they thought we were mad. But you quickly come to realise that they were right and
we were wrong. (Transcript 3, Section 146)
One girl was a mischling, meaning half Jewish half German. her father was a
German, she was thought of being Jewish but she wasn’t, not quite. Her name was
Hannalore something, terribly German, and she was a singer, a sort of popular
singer. I can see her, Hannalore, whatever her name was, and she sang one of the
popular songs of that time. That was apocalyptic, because you felt like listening to a
song like you felt like going to the gas chamber. (Transcript 3, Section 467)
Auschwitz was twenty-four hours sort of thing so you were afraid all the time. But
the one thing when we arrived in Mauthausen which is a beautiful village on the
Danube and the sun was shining, and the greenery was starting to come out, it was
the 29th April and I was sitting on those carts at the beginning of a baby coming and
I looked at the beautiful countryside and the sunshine and the greenery and until
today I remember how much I liked it. And I honestly had other worries other than
looking at the sight seeing part of it. I really couldn’t explain to myself, “why did I
look at the countryside and the Danube underneath and the Melke Abbey not far
away?” (Transcript 3, Section 413)
The researcher joined in the research conversations to ask specific questions, seek clarification or
offer support. This is illustrated in the excerpt below, where, with dark humor, Anka recalls the
place of music in the camps:
Author: It was in the barracks, this so called entertainment took place?
Anka: Yes, but the reason for it is totally . . .
Author: Is that similar to playing in the orchestra as people were being taken . . .?
Anka: That is a different story, the orchestras. The orchestras played every day,
when people went out to work and then when they came back.
Author: They tried to keep people calm?
Anka: Pretending that people go to work and will come back. (Transcript 3, Sections
480-485)
Table 2 offers an example of Anka’s health interview, indicating both Anka’s style of speech and
the content of the research conversations. Unlike the life history, which provided an overall
picture of life events, the health interviews were designed to enable the researcher to home in on
aspects of her life as they related to her physical, emotional, and mental health and well-being.
These interviews, which took place after the life history was told, concentrated on Anka’s
responses to questions about her ongoing health and well-being, such as,
•
What did good health mean to you during your time in the camps and what does good
health mean to you now?
•
How was your health and well-being affected by the camp experience?
•
Were there ways in which your physical and mental health as a child and young woman
impacted on your camp experience?
•
How would you describe your current state of physical and mental health?
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These questions were designed to ascertain the relationship between health, well-being and the
trauma of the Holocaust, to understand more clearly the continuum of health and well-being
during the course of a lifetime that has been influenced by such an extraordinary event and to
clarify the health narrative or interrupted health narrative as it relates to Holocaust events.
Undertaking summative analysis:
Application of the process to the Holocaust text
Stage 1. Summative analysis begins with a written paragraph produced by each coresearcher
(approximately 25 lines of text) that is written in response to the raw material provided by the
research subject’s transcribed testimonial. The aim in Stage 1 is twofold: to introduce
coresearchers to the text and to enable them to begin to consider what an “essentiality of text”
might look like. Stage 1 is perhaps the most challenging aspect of the whole process.
Coresearchers have to think not only about what to write in their brief paragraph but how to write
in a rigorous and crystallized fashion, keeping the relationship between speaker and audience and
between what might be contained in the whole text and what is contained in its part(s), in mind.
This enables participants to capture the fundamental elements of an experience as a first attempt
at understanding the work they are considering (see Table 2 for some examples) .
Coresearchers read and reread the raw material before undertaking any writing to familiarize
themselves with the data and gain confidence in their response. Initial forays into the data can
take some time, and the study brief is left purposefully broad to encourage limited researcher
influence (Rose, 2000; Author’s name et al., 2008). Consequently, a number of stylistic and
Table 2. Excerpt from Anka’s health interview
I never remember being ill. I don’t remember ever having any problem with my health, so I never thought of it. And I
survived three and a half years in the camps, and the birth of two children. Shortly after we came back I caught a
streptococcal infection in my leg. Apparently it happens if there is a small cut or abrasion: “Erysipelas, an acute
infectious disease due to a specific streptococcus and characterized by diffusely spreading deep red inflammation of the
skin or mucus membranes.”
I seem to have been blessed with a very optimistic state of mind. That helps enormously. You can push things. I think
about tomorrow, which I have done perhaps not all my life but through the three and a half years in the camps, and I
carry on with it now. The opposite would be to suffer from things which perhaps are imaginary and not to count your
blessings. But I think this “count my blessings” really would summarise my point of view. Everybody else was bent
and I wasn’t. I am not going to give in. This is totally irrational because I really didn’t have any reason to think that
nothing will happen to me, but, I knew that I will come back unscathed. I had a most happy childhood and young
girlhood and my first one and a half years of being married, when we were still in Prague . . . Going to school was a
pleasure. I loved that—elementary school, high school, university . . . I couldn’t have had a nicer childhood or teenage
life, and the first two years of university was heaven. There were no problems.
The physical was always there, so it was accepted as a norm; and the mental, well one had to face so many decisions
that you couldn’t do anything about it. So many things happened and you still stood there and carried on. I always
looked on the bright side, I always looked up and not down. My physical saved my life. When you arrived in
Auschwitz on that ramp: “left right, left right.” Dr Mengele took one look at me and put me on the side that are fit, and
my pregnancy didn’t show because that would have put me definitely on the other side. But then I went through I don’t
know how many of these selections, running naked through Auschwitz. We are stark naked, sort of parading in front of
him. I don’t think they looked at us as human beings: “is she healthy enough to work?” That was the only criterion. I
was glad that we went on this side and not the other side. If it had happened that I went on this side which was life and
my friend went to the other side, I was glad that it isn’t me and that it was somebody else. I am describing how low one
can get. It’s only, “me, me, me,” and I am not a very selfish person, but if it’s life and death you choose life. I don’t
know if you can understand because you have never been in a situation like that. You don’t do anything for it or against
it, but you are relieved that you go this way and everybody else goes that way. It has nothing to do with the other
people, but you have been chosen to live.”
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representational forms can result from Stage 1. Previous coresearchers have presented their short
writing in a number of different ways, such as in the first person or in the voice of the storyteller,
where the story is presented in its entirety but in a highly abbreviated fashion; in the third person;
or more formally, with writing that touches on only certain sections of text while leaving others
out entirely. Some people have summarized the issues in question, often doing so by placing them
within an entirely new story of their own making. The researcher has also encountered responses
in bullet-point form, people making comments using a memo of contents, or offering verbatim
quotations to draw a pathway through the text. Whereas for some, their own words and thoughts
are paramount, for others it is the storyteller’s words and thoughts that matter. In some cases,
coresearchers are highly analytical, with few noticeable descriptors. In others, coresearchers
depend solely on descriptive phrases, and in still others, coresearchers are interpretive, deciding
what the storyteller was trying to put across and the meanings belying the text.
How to present the integral elements of text is up to the individual, although the researcher must
carefully compile an overview of group meaning and presentational style in readiness for Stage 2.
What should be apparent at the end of Stage 1 is that coresearcher presentations encapsulate the
key issues within the text and, similarly, that the superfluous issues—those not included in
individuals’ paragraphs but nevertheless present within the original raw material—lie outside the
text’s essentiality. The superfluous issues are not without merit, but nevertheless there are some
aspects of the raw material that are extraneous to the text’s irreducible essence.
During a 10-month period of work in the United States, between January and October 2009,
seven groups of coresearchers comprising health practitioners, other professionals, researchers,
and academics took part in workshops using summative analysis to clarify how notions of health,
illness, and well-being were presented within a section of narrative from Anka’s health interview.
The purpose of the workshops was both to explore narrative effect and to examine whether, and if
so how, the Holocaust affected Anka’s health and well-being. Coresearchers displayed mixed
levels of qualitative expertise, from little to extensive expertise. Coresearchers were also widely
multidisciplinary, from lawyers and social scientists, to health care researchers, narrative
specialists, psychiatrists, psychologists, and social workers. Coresearchers were involved on a
voluntary basis, having either expressed an interest in the method or in the Holocaust data. Fifty
coresearchers took part from across higher education institutions and professional bodies,
including Harvard University, Brandeis University, Boston College, Boston University, the
University of Massachusetts, and the University of Texas Medical Branch. Tables 2 to 4 offer
examples of the different stages of summative analysis drawn from the U.S. workshops, with
Table 2 illustrating three very different presentational styles from Stage 1.
Stage 2. On completion of Stage 1, the researcher re-stories the data in terms of the group’s
findings and presentational styles, in readiness for Stage 2. This involves a careful crafting of data
outputs, taking account of writing style, issues raised and coresearcher understanding. The
researcher must be aware of the frequency with which notions are presented as this influences the
way key points are grouped and listed under developing topic-oriented headings. In addition, the
researcher must consider the relationship between concepts within and across paragraphs,
similarities and differences between emergent themes, and resonance across and between groups.
Thematic or topic-oriented headings are classified according to those containing issues that all
coresearchers mentioned, those containing issues that most coresearchers mentioned, and those
containing issues that only a few coresearchers mentioned (the outlier positions), a kind of
directed and hierarchical map. However, although outlier positions might be perceived as at the
end point of this hierarchy, their presence in the map is of no less significance, and it is up to the
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Table 3. Examples of coresearcher responses to Anka’s health interview
Coresearcher A
Anka survived three and a half years in three different concentration camps. Her account uses repetition, shifting
pronouns, changing verb tenses, and quoted speech to try to convey an experience that is almost unbelievable and
almost not understandable to anyone who was not there (or who has not been in a situation like that). Telling the tale is
a way for her to ensure that the truth of the experience will be carried on even after all the survivors and their children
have died, from the vantage point of someone who is almost 90 years old and anticipating her death. Anka divides the
experience into a binary, starting with the first line: “I never remember being ill.” This is repeated throughout the
account. But her account is filled with illnesses: streptococcal infection, scarlet fever, whooping cough, mental
deprivation, malnutrition (starvation), premature labor and stillbirth. She disconnects her body and her mind: She had
to be healthy to survive (life and death you choose; there was no room for anybody ill) and to make the cut (sent to the
left or to the right), and to leave her body, use her mind to make decisions including the decision not to be ill (mind
over matter; you could accept it or you go mad). She disconnects herself from others (It’s only me, me, me) and mourns
what she can know because otherwise the experience is too big even for her to believe. The quotations provide a kind
of inner dialogue about how she survived and what she sacrificed to survive, no past, no future, just the present and the
need to know what she wants and doesn’t want and to will it into existence: “Is she healthy enough to work?” “Will I
get through this time?” “Tomorrow, I will think about it tomorrow.” “This is it.” “You do some programme.” “Where
was he?”
Coresearcher B
“I never remember being ill . . . And I survived three and a half years in the camps”
“And the birth of two children”
“I seem to have been blessed with a very optimistic state of mind”
“That helps enormously . . . I think about tomorrow”
“This ‘count my blessings’ really would summarize my point of view”
“Everybody else was bent but I wasn’t . . . I always looked on the bright side”
“I was glad that it isn’t me and that it was somebody else”
“I am describing how low one can get . . . It’s only, ‘me, me, me’”
“If it’s life or death you choose life . . . It has nothing to do with the other people”
“But you have been chosen to live . . .”
“The more you were in a camp the more you knew . . . how to live”
“There was hunger, real hunger there . . . Only the pioneers knew where to turn”
“You got frightened that it could happen any day . . . One had to cope with whatever came”
“I think one had hope and it proved right . . . The fear was overpowering”
“In these circumstances you have to make your choice, what’s important”
“We didn’t look and we didn’t care . . . Because you get so selfish”
“Even with those three and a half years which were anything but happy or normal”
“I am here to tell the tale”
“In the next two generations nobody will know what is really true”
“The story should be believed . . . That’s what I try to say”
Coresearcher C
The essential quality of this text is the resilience of the human spirit/psyche; the human capacity to endure trauma; and
not only to survive it but to thrive in its aftermath. Anka’s narrative reveals key values essential to appropriate coping
and integration of traumatic experience necessary for health and well-being: the ability to externalize or defer negative
information/experience [boundary management] [“I can push this thing off”]; the ability to maintain a positive attitude
[gratitude, hope]; the ability to maintain one’s sensory integration abilities enough to feed/maintain that positive
orientation [the purely sensory appreciation of the beauty upon arrival to Mauthausen]; the ability to focus on the
essential tasks/choices, without distraction from essentially (in the context) superfluous input [life/death vs empathy,
compassion or concern for others/parents]; the converse ability to retain/regain a porous nature, essential for
meaningful human life [vs hermetically sealed, dissociated, psychopathic aftermaths]; the ability to adapt to the milieu
[blend]; and the lasting ability to weave meaning from the experience in an manner which permits all of the above
[reasons to remember]. Though she brought some of these qualities to her experience of trauma [“I don’t talk about my
parents b/c they wouldn’t have burdened me with that”], increasing her chance of survival/thriving, many of these
emotional/physical survival skills were forged as a result of her experience.
group to consider the positioning of items within the outlier group, rearranging them as necessary,
subsuming them within other topic headings, or changing their position to enhance understanding.
Indeed, it is often the outlier positions that hold the key to understanding other elements of the
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map as a result of their relationship to other topic headings and themes. The researcher must
judge how best to group, classify, and clarify the work and, under working thematic headings,
how to return to the group with a synthesis of their work that is both understandable and adaptive
to further activity. This aspect of analysis is strongly dependent on the study aims and objectives
and the desired outputs, which may differ on each occasion and with each new research study.
For example, the aims of group work may be to develop policy or educational materials, to arrive
at a specific endpoint for an empirical study or to consider theoretical aspects of the study. In this
case, Holocaust workshops aimed to clarify whether, and if so how, health and well-being was
present in the context of the survivor’s story. The researcher imagined that the effect of Anka’s
time in the camps, especially her experiences of losing a child, hiding a second pregnancy, and
then giving birth on an open, typhoid-infested coal wagon, might have had a strong influence on
her health and her future health expectations.
During Stage 2it is important that the researcher/ facilitator avoid interpreting outputs, leaving
that to the latter stages of analysis, but nevertheless the facilitator should keep in mind the
interpretive stance of coresearchers thus far. Table 3 provides a detail from Stage 2 analysis from
one of the U.S. workshops.
Stage 3. Stage 3 is the development of a single long, group paragraph approximately 30 to 35
lines in length that summarizes the researcher’s synthesis of the coresearchers’ work in relation to
the ongoing, iterative account (see Table 4, for example). Stage 3 is detailed and deliberate and
can take a number of meetings to achieve depending on the degree to which consensus is reached
and the complexity of the issues involved. During Stage 3, all coresearchers work together to
create a final paragraph, discuss each other’s work and the work of the facilitator, and outline
what the group paragraph should contain. To achieve this, coresearchers refine emergent themes,
reword or confirm thematic or topic-oriented headings, and consider the order of key concepts
and their concomitant categories. This process continues until all members are in agreement that
the essential aspects of text have not been lost and, furthermore, that they have been captured
succinctly and convincingly. Not only must coresearchers come to know each other’s views, they
must also be able to make careful choices regarding style and presentation of the group’s work so
that wider audiences can recognize the evidence within. At its best, Stage 3 can be a highly
effective, positive collaboration.
The researcher/facilitator, mindful of each coresearcher’s part in the discussion, should encourage
people to be equally and effectively involved through open debate so that differences of opinion
can be confidently aired and debated. In addition, coresearchers are encouraged to acquire the
skills necessary to hone down qualitative data to a final paragraph. Of the themes pertaining to
issues that all coresearchers raise, the most vital are considered in detail, whereas outlier themes
might be considered more briefly unless they are repositioned, reordered, or removed entirely,
according to the final “order of essentiality.” The researcher/facilitator’s role is to lead, probe,
and suggest but not dictate to the group the content of the final paragraph, which should be a
mixture of storied text and verbatim quotation. Consequently, the final paragraph is more than a
sum of its parts. Rather than being seen as the researcher’s output alone, it pays homage to the
collaborative strength of the method and the staged process. It indicates a depth of working and
thought that has gone into the re-presentation of a participant’s story through both personal
awareness and the collective voice.
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Table 4. Detail from Stage 2 analysis
Everyone mentioned:
Coping mechanisms
Resourcefulness: finding ways to survive to “carry on”
Postponement: “I will think about it tomorrow”
Denial: denying her feelings this is in relation to the scope of the trauma
Integrity v. despair: Eriksonian developmental stage (own health doesn’t alarm her)
Muted emotional response: to brutality, loss and privation
Detached descriptions: (detaching herself from her own feelings and experiences)
Accepting: situation’s horror in order to focus energy on survival
Shutting down: thoughts and believing in her own survival (selfishness, introspection)
Limiting herself: looking out for herself and her camp friends (propped her up)
Happy recall: childhood, supportive family, helped overcome major difficulties
Surface thinking: thinking not too deeply protected mental and physical health
Finding hope: looking to the future, believing in survival for her and her daughter
Coping with whatever came: day-to-day functioning, fundamentals of survival
Psychological resiliency: “I’ve been blessed”
Avoidance: of certain memories (shoes of babies, glasses, people, number of dead)
Active role: not passive recipient (not a victim, she has choice of what’s in her mind)
Some people mentioned:
Anka’s health
Sickness expressed in a detached way, yet AB doesn’t say her physical health suffered from the experience
Willed herself to remain healthy (execution was the alternative to work)
Discussed health in terms of: work, hunger and deception
Health = Community, bonds to friends, attachment to family
Health = Social support necessary to maintain that one can still work
Health = Maintaining the illusion of good health
Health = Hiding her pregnancy and being seeing as able to work
Becoming ill was not an option
Anka’s lack of illness = Emotional well-being and making choices
Concept of illness is fragmented (emphasis on the mind)
Maintaining her mind will enable her to avoid illness (kidneys don’t work well, but “if I can get out with my mind still
working and my body saying not any more”)
Anka “never remembers being ill”
One or two people mentioned (outliers):
Denial of food, housing, and personal dignity
Enforcers were cruel, inhumane, tormenting
Persecuted were tested on their own limits of humanity, justice, and integrity
Starvation, minor illness, brutal anti-Semitism, physical and mental torture
Parents would not have burdened her with complaints of their hunger
Good physical health was linked to one’s age and transport group
Concentrating on fundamental issues: basic survival, self-preservation
Camp regimes were built on fear, repression, and humiliation
Experience is considered before, during, and after the Holocaust
Experience is presented in past, present, and future tenses (who will take this forward?)
Looking back and being taken back (in a bodily sense)
Tacking back and forth in the narrative between staggering events of Holocaust and determination to cope, accept, or
go mad (factual and personal approach?)
Stage 4. Two aspects of the method make summative analysis unique within the qualitative
methodological analytic portfolio. First, summative analysis emphasizes the importance and value
of coresearchers being open, honest, and mutually supportive of each other during the groupworking activities, which encourages them to feel strongly involved and to want to achieve
mutual understanding of the text. This encourages coresearcher concordance and the development
of group understanding. Second, summative analysis ensures that, first as individuals and then as
a group, coresearchers are supported in working together to home in on an understanding of the
essential properties of a text. By moving through the method with clear guidance from the group
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facilitator, coresearchers arrive at a position of knowing the text in its significant aspects, and
through further reflection, during Stage 4, offering detail to each of the significant aspects. This
manner of working toward group understanding and clarifying the irreducible essence through its
complex aspects is unlike any other qualitative analytic approach, which usually begins with the
wider canvas before moving on to the irreducible essence. In addition, this approach enables
people to work from the research question to the research output steadily and consistently through
the group-working sessions, with the final group paragraph achieved within only two or three 2hour group-working sessions.
Once the group paragraph has been written, coresearchers are encouraged to “explode” or
“unpack” each of the elements that make up the paragraph, during a final group-working session
during Stage 4. From the group paragraph to the elaborated elements, still ordered according to
the final paragraph, coresearchers embellish their original group understanding. Where the
essentiality of text is not clearly grasped during early stages of analysis, this process might be
more difficult to achieve. However, summative analysis is particularly effective in enabling
coresearchers to find meaning more readily, having gone through the previous three stages and
having come to know the text intimately, as a group, through group discussion and reflection.
This is also the stage where the coresearchers can take a more analytical or interpretive stance,
presenting their views and opinions in relation to the storyteller’s narrative. Here the facilitator
can bring to bear the interpretive considerations that were recognized in earlier stages of working.
Stage 4 is the stage when nuance or ambiguity within the data, which may have arisen in relation
to how meaning is derived, is given full consideration. For example, as the group paragraph
presented in Table 5 illustrates, workshop coresearchers in this particular group discussed the
ability of survivors such as Anka to mute their own emotional response to others’ suffering, to
blinker down” or shut out negative thoughts, to guard against the full impact of the trauma
Table 5. Example of a group paragraph from Stage 3 analysis
Anka spent three and a half years in Terezin, Auschwitz, and Mauthausen concentration camps. In her “life and health
story” she considers good physical health saved her life. She displays extensive psychological resilience and an
indomitable will to survive, having the ability to see whatever is positive in life and describing herself as: “being
blessed with a very optimistic frame of mind”. She applied techniques during the Holocaust such as forward thinking—
“choosing life”, “looking up and not down”, and even in extremis, maintained a sensory appreciation of the world. She
found pleasure in the countryside around her as she descended the hill from Mauthausen during her baby’s birth, on an
open, typhoid-infested coal wagon, saying, “I really couldn’t explain—why did I look?” Her positive disposition meant
that she was grateful for the good things: “this ‘count my blessings’ really would summarise my point of view”. During
the Holocaust she managed to disconnect from others’ suffering. She describes this as a way of coping, muting her
emotional response by shutting out negative thoughts that health professionals suggested later helped her minimize
trauma. Whilst she sees this as perhaps “selfish,” she also recognises that it helped her concentrate on her own survival:
“I will think about it tomorrow, like Scarlet O’Hara in Gone with the Wind.” Anka’s narrative indicates a clear
interrelatedness between mind and body, but also a detachment from her own feelings and experiences: “Everybody
tried to keep healthy because as soon as you weren’t healthy, you were gone.” She says that her body and mind saved
her life—“Everyone else was bent and I wasn’t. I was not going to give in”—and her defiant attitude emphasises a
resilience of human spirit and the human capacity to endure. Anka successfully pushed off the harsh realities of life,
both mental and physical, and continues to have a strong sense of self-esteem, established through her early years: a
comfortable childhood, loving parents, and good upbringing. During the camp years there was a strong social support
system—her Transport group—a group of youngsters who came together, stayed together, and helped maintain good
health and wellbeing. Whilst her own strength and coping mechanisms were fundamental to self-preservation, they still
appear to influence her today. Anka says, for example, that she never remembers being ill—“I always tried to keep
healthy”—but describes many illnesses, especially in later years. Using mind-over-matter tactics, she now wishes to
look to the future, accept things as they are, and not give up hope. She wants to die in peace without being a burden to
her daughter or herself. She wants to find a suitable ending to her life: “if I can get out with my mind still working and
my body saying not anymore, well alright, I had a long life and a very healthy one”. She hopes that by telling her story,
the memory of those who perished will be honoured and people will realize the full extent of what “one human being
can do to another” so that the Holocaust can no longer be denied. That is fine!
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“perpetrated on others, and by so doing to find an appropriate personal coping mechanism.
Although notions such as these have been psychologized extensively in the literature on trauma
(see, for example, Candib, 2001), where the effects of somatization or posttraumatic stress
disorder (PTSD) are said to lead to a range of complex coping mechanisms for dealing with
human suffering, coresearchers in this group were in agreement that PTSD did not adequately
convey the nuance of the coping experience. Nor did such labels illustrate the manner in which
the weight of suffering is carried through an individual’s life, which the trauma narrative can
more readily reveal. Coresearchers pointed to a host of anomalies within Anka’s story, which
were identified as markers of her lifelong process of coping developed across her narrative that
helped to clarify her muted emotional response. These included Anka seeing herself as behaving
selfishly in the camps (“It was only me, me, me”), with a sense of shame that others were “sent to
the other side.” She says, “I was glad we went on this side, the side that was fit” while
recognizing that she needs support from others to find food for loved ones, to prop people up
during roll calls, and to consider others’ best interests through community actions. Other
anomalies included Anka’s response that one could choose to survive while acknowledging that
all choices were taken out of one’s own hands. Her desire to look to the future and uphold a
positive attitude, while considering how she “never thought about tomorrow,” the ability to
switch off to survive while appreciating the necessity to be very aware and tuned in to life in the
camps, the ability to conceive of the visibility of horror while wishing to remain invisible: These
are just a few of the examples of seemingly contradictory statements embedded throughout
Anka’s text. Having written the group paragraph, the coresearchers exploded Anka’s ability to
mute her emotional response to suffering during Stage 4 to clarify whether these were indeed
anomalies or paradoxes. Stage 4 enabled the group to agree on the notion of a sliding scale of
experience that indicated nuance of coping with pain and suffering through this “range of
experiences” rather than what was initially perceived as surprisingly contradictory statements.
Challenges of summative analysis
There are a number of challenges to the method worthy of note. First, it is important to ensure
that no more than six to nine coresearchers participate in each workshop, though the researcher
may choose to work through the four stages with more than one group. Too few or too many
coresearchers can affect the length of the sessions and disturb the balance of discussions. With
this number of coresearchers, the researcher/facilitator avoids being in the position of dominating
too small a group or losing voice with too large a group. The role of the researcher/facilitator is to
ensure that all workshop coresearchers have an equal say in discussing the text under review
while recognizing the need to encourage quieter members of the group if necessary. Workshop
groups of this size allow for individuals to appreciate each stage of the method and for the group
to support a dynamic discussion that runs fluidly, with full coresearcher input. Second, the
management of the workshop session is crucial to the success of the method. As with the
management of face-to-face interviews or focus group meetings, the facilitator must be well
versed in the method and familiar with its development across all four stages. The
researcher/facilitator must be confident in supporting the coresearchers to achieve the method’s
full potential, helping the group overcome any disagreements and resolve uncertainty with the
aim of achieving overall consensus through group activities.
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Implications of the summative analysis method
for a wider research audience
In this paper the author has concentrated on how summative analysis can be applied to one
specific empirical research study. However, the implications of its use can be considered within a
wider research context. It is particularly useful for documenting and describing others’
experiences, and can deal with difficult, traumatic, emotive, or sensitive material presented from
individuals or from groups. In the case of groups, they may be disenfranchised, diverse, or
mainstream. In addition, as the wide-ranging examples in the introduction section suggest,
summative analysis is useful for addressing scientific problems in applied health research.
In terms of its use within a wider research context, first it is important to note that when dealing
with others’ life stories in narrative form, whatever the data or field, there must be an appropriate
fit between the study aims and, on the other hand, the data collection and analysis methods so that
the story teller’s subjective understandings can be revealed. As Schiff and Noy (2006) have
reminded us, for each story there is not only a research question that needs to be addressed but
also a real life person behind the data:
Listening closely to talk, how tellers describe who they are and where they come
from, life stories allow us to explore subjective understandings in great complexity
and draw interpretations about how persons make sense of self and world. (p. 15)
Summative analysis takes stock of these relationships and the cultural aspects of experience
(Schiff & Noy, 2006) within the context of the story being told and the questions being asked. It
is particularly sensitive to the voice of the speaker, the speaker’s style of presentation, and the
speaker’s intent.
Second, as the Holocaust testimonies remind us, what might today be considered
autobiographical memory can quickly become “historical memory” (Bendix, 2004, p. 133). In
terms of the Holocaust, only about a quarter of those who lived through the 1930s and 1940s in
Europe are still alive. When the notion of “collective memory” becomes one that is “literally
vanishing” (p. 133), there is an added urgency, an added imperative, perhaps even a moral
imperative on the part of researcher to expose the story while paying close attention to the voice
of the storyteller and his or her part in telling the story. That is to say, the researcher must be
attentive to not only what is being spoken about, but how it is being spoken about and how this
re-stories understanding. The researcher’s task is to value the oral nature of testimony; to see it as
a living, breathing dynamic while recognizing that at some stage it will change to an historic
artifice. In effect, collecting stories from survivors and analyzing them appropriately, although
recognizing the importance of the face-to-face encounter, alerts researchers to the moral
implications of their work and to their role in taking messages forward. In the case of this study,
as Anka implies below, this might even affect the collective consciousness of future generations.
The storyteller might be well aware of this, as in the case of Anka, but it is not always so:
Even with those three and a half years, which were anything but happy or normal, I
am here to tell the tale. It was quite an experience, which not many people have lived
through and perhaps it helps somehow to tell the tale, not to me but to the future
generation, and who can tell the tale? It’s very important because there are so many
people who deny it and as long as I am here . . . But I thought it might die with me. It
might die with my daughter who carries the job on, but that’s not enough. So the
more people that know it and know that it’s true, that it did happen, for no reason
whatsoever. The number of people who deny it is growing. They should know it
because that’s what one human being can do to another . . . As we will all die out
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within the next ten years, who will carry the torch? History is a subject you can turn
this way and that, in the next two generations nobody will know what’s really true.
The story should be believed, that’s what I try to say. (AB, Transcript 3, Section
533)
Expectations such as these can apply to a range of narrative contexts, where researchers are
working with particularly pressing, sensitive, harrowing, or difficult stories. These narratives are
never offered up lightly, and the researcher must be aware that there is often an expectation of
something in return for an individual’s unburdening. This is akin to the research subject gifting
their story to someone else’s care, and by accepting the gift, the researcher is agreeing to enter
into a close relationship and take on the responsibility of the story (Mauss, 1990; Titmuss, 1997).
Though the nature of the relationship might vary according to the nature of the gifted narrative,
gifting offers a story an added sense of urgency and vitality: It makes a story real. As a result, it
has an empowering effect, both on the storyteller and on the listener. To deal sensitively and
appropriately with the expectations of a story gifted, researchers should apply an allencompassing analytic technique that provides that something in return and even something to be
continued. Through the use of summative analysis to uphold the speaker’s original voice
inference while taking a story forward through a group-working process that recognizes the
speaker’s original intent, researcher responsibility can be well earned. Summative analysis can
accommodate varied and complex aspects of text toward a successful transformation and can
keep the storyteller fully informed about the analytic process. This closely informative approach
provides the person telling the stories a sense of ownership over them right up to the time of
delivering study outputs.
Finally, the Holocaust study was designed to clarify whether notions of health and well-being
were in evidence in survivor testimonies and what that might tell us about the ongoing needs and
expectations of people suffering extraordinary, traumatic events and their family members. The
purpose was to identify aspects of Holocaust narrative that might lead health care professionals to
be better attuned to the particular needs and interests of this survivor group. Although the
literature indicates great interdisciplinary interest in trauma and health research around suffering
(Kansteiner, 2004), the literature is also quick to label survivor stories according to their
psychosocial effect and in accordance with a symptom-oriented, medical model rather than in
accordance with a wider social and emotional picture. Labels such as PTSD, “characteristic
symptoms following exposure to an extreme traumatic stressor” (American Psychiatric
Association, 2000, p. 463), can become a blanket cover for all things medical. This then becomes
the challenge to the researcher: how to explore and present a story in its fullness but in a way that
moves beyond psychosocial labels and symptom-driven accounts. Summative analysis allows
people to grasp the compelling aspects of an account through re-presentation that is summative. It
has the potential to extend understanding beyond the medical, psychiatric, legal, or theoretical
expertise that at best can be considered lacking and at worst may contract or compete with the
interests of the storyteller and their family.
Note
1. The terms protagonist, storyteller, and research participant refer to the Holocaust
survivor who gave up her story to the author.
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